sialolithiasis (salivary stone)

Introduction

Etiologu:

• decreased salivary gland flow predisposes
• risk factors
  • hypovolemia
  • diuretics
  • anticholinegics
  • smoking
  • periodontal disease
  • history of nephrolithiasis

Epidemiology

• 1/15,000 to 1/30,000 per year

Pathology

• stone generally in the duct of a major salivary gland
  • submandibular gland Wharton duct in the floor of the mouth
  • parotid gland Stensen duct opens opposite 2nd upper molar
• stones cause sialadenitis

Clinical manifestations

• parotid or submandibular gland swelling
  • much more common in submandibular glands than parotid glands
• repetitive swelling during meals
  • acute pain & swelling may occur in anticipation of eating or during eating
  • pain & swelling is often transient but may persist
• a stone may be palpable

Complications

• bacterial infection

Differential diagnosis

• salivary gland neoplasm:
  • generally painless
  • lymphadenopathy & facial paralysis suggest malignancy
• sarcoidosis & Heerfordt syndrome:
  • fever, uveitis, & parotitis with or without facial nerve palsy
• Sjogren syndrome: dry eyes, dry mouth, no mass lesion

Management

• stimulation of saliva production with warm compresses
• sialogogues: sour candies or vitamin C lozenges
• salivary gland massage
• increase oral fluid intake
• oral hygiene
• sialendoscopy for removal of salivary stones
  • lithotomy
  • surgical resection
• extracorporeal shock wave lithotripsy (investigational)

More general terms

• abnormal morphologic structure (malformation)
• calculus

Additional terms

• salivary gland
• sialadenitis